Topical Anti-inflammatory Drugs Research Articles

Local concentrations of secretory immunoglobulin a in patients with adenoiditis, rhinosinusitis and exacerbation of chronic purulent otitis media when using physiatric methods in complex therapy

Improvement of therapeutic tools is one of topical issues in modern otorhinolaryngology. The article is devoted to the study of the stimulating effect of physical therapy on the concentrations of secretory IgA in nasal secretions, from the entries of auditory tubes and nasopharynx in the patients suffering from adenoiditis, rhinosinusitis, and exacerbation of chronic otitis media. The increase in clinical and immunological efficiency when using low-frequency ultrasonic cavitation therapy in combination with photochromotherapy in combined treatment of these conditions was evaluated in dynamics by measuring concentrations of secretory immunoglobulin levels in nasal secretions using enzyme immunoassay technique (Vector-Best, Russia). The purpose of this study was to improve clinical and immunological effectiveness of treatment of patients with chronic adenoiditis, sinusitis and exacerbation of chronic purulent otitis media when using low-frequency ultrasound cavitation and photochromotherapy in complex therapy. The study involved 54 patients. The control group consisted of 25 patients who received conventional treatment (topical and systemic antibacterial and anti-inflammatory drugs, unloading and elimination procedures, symptomatic and restorative therapy) and the main group of 29 people who, in addition to etiotropic therapy, received low-frequency ultrasound cavitation irrigation of the nasal cavity followed by a course of photochromotherapy. Evaluation of the effectiveness of treatment was carried out by studying the barrier state of the nasal mucosa by the levels of secretory IgA concentration by the method of enzyme immunoassay. The low-frequency ultrasound cavitation in combination with photochromotherapy as an adjunct to etiotropic treatment in patients with adenoiditis, rhinosinusitis and exacerbation of chronic otitis media promotes an earlier increase in secretory IgA concentration of nasal mucosa and entry of the auditory tube when compared to standard treatment methods. The trend to IgA increase by 14 days reached maximal values and was slightly decreased month later. An early increase in the concentration of secretory IgA in nasal secretions and the entry of auditory tube, and positive clinical results of treatment are observed when low-frequency ultrasound cavitation is used in etiotropic therapy in combination with photochromotherapy in patients with adenoiditis, rhinosinusitis and exacerbation of chronic otitis media. The results substantiate the opportunity of introducing these physical methods of physical therapy into complex etiotropic therapy, as a non-invasive and effective method.

Otitis externa: a roundtable discussion

Otitis externa is a common problem in both primary care and referral practice. A wide range of factors contribute to the successful management of disease. A logical approach and investigation are important and should always include an appreciation of underlying primary causes, predisposing and perpetuating factors, and secondary infection. Cytology is essential to help choose appropriate therapy and represents an opportunity to use the expertise of the nurses within the veterinary team. COVID-19 has forced many veterinary professionals to use remote consultation techniques to provide care for patients and it may be that some of the lessons we have learned during lockdown can be applied to our working practices to improve the level of veterinary care in the future. The selection of appropriate topical anti-microbial and anti-inflammatory drugs is, of course, important but without good levels of owner compliance even the best therapy is ineffective. This article presents the outcome of a workshop in which a group of experts discussed many of these topics.

Comparison of topical and intracameral nonsteroidal anti-inflammatory drugs on pupillary size and postoperative inflammation in cataract surgery

Comparison of topical and intracameral nonsteroidal anti-inflammatory drugs on pupillary size and postoperative inflammation in cataract surgery

Comparison of Virgin Coconut Oil with 5% Amlexanox in Management of Minor Recurrent Aphthous Ulcers - A Randomized Control Trial

Objective: Recurrent Aphthous Ulcer (RAU) is a common (75-80%) painful inflammatory ulcerative disorder of the non-keratinized oral mucosa. Wide range of antiseptics, anti-inflammatory, antibiotics and corticosteroids are available for treatment. Amlexanox is a topical anti-inflammatory and anti-allergic drug used to treat RAS. Recently, there has been increase in interest in use of essential oil and herbal medicine in managing RAU, one such natural product is virgin coconut oil. This study is aimed to determine the efficacy of VCO in management of signs and symptoms of minor recurrent aphthous ulcers. Methodology: 40 patients were included for the study who were randomly divided into two groups. 20 patients in Group A (VCO) and 20 patients in Group B (5%Amlexanox). Primary outcome measured were reduction in ulcer size (in mm) and pain (VAS 1-10). Results: There is high statistical significant difference within the groups in ulcer healing and pain reduction (p=0.00) on 3rd and 5th day. In group A significant reduction in pain was present on the 5th day (p=0.02) and no significant reduction in ulcer size (p=0.083). No adverse effects were reported in either group. Conclusion: VCO could be used as an effective and safe drug in managing the signs and symptoms of RAS. It is edible oil with no known adverse effects and could be a safe therapeutic alternative in children and pregnant women.

Modern aspects of inflammatory external ear diseases treatment

The article deals with the problem of inflammatory diseases of the external ear. A review of pruritic dermatoses of the external auditory canal was carried out. It has been shown that in chronic dermatoses, the contamination of the skin with bacterial and fungal pathogens significantly increases, which leads to a high risk of developing secondary infectious pathological processes. Treatment of dermatological inflammatory ear diseases includes careful daily hygiene of the external auditory canal and pharmacotherapy, a key aspect of which is the use of topical etiotropic, anti-inflammatory, and symptomatic drugs. The advantage of the combined drug candiderm is described, which, thanks to the unique combination of beclomethasone, gentamicin and clotrimazole in the composition, effectively relieves the symptoms of external ear dermatoses.

Feline Eosinophilic Keratoconjunctivitis: Nonsteroidal vs Corticosteroid Topical Treatment

Background: Feline eosinophilic keratoconjunctivitis is a proliferative eye lesion of chronic aspect with usually unilateral presentation that may initiate as a superficial vascularization that evolves to a proliferative, granular, irregular lesion of whitish-pink aspect. With its association with an immune-mediated response, nonsteroidal anti-inflammatories do not appear to be efficient, although few studies describe its use. This case report describes a case of a feline eosinophilic keratoconjunctivitis with its clinical evolution since the use of nonsteroidal topical anti-inflammatory drug in an undiagnosed patient and the transition to a topical corticosteroid and cure after 14 days since diagnosis.Case: An 8-year-old female cat was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an eye injury with at least 36 days of evolution andunresponsive to treatment (topical tobramycin 0.3% every 12 h / ketorolac trometamol 0.5%/ every 12 h and ophthalmic lubricant/every 4 h). Since the patient had free access to the street, the owners suspected of trauma-induced lesion. At physical examination, it was observed a proliferative lesion at the peri-limbal superotemporal quadrant of the right cornea with approximately 0.4 cm diameter, with color varying of pale to pink, with irregular surface and low vascularity, the adjacent conjunctiva was also affected with similar multiple nodular lesions (0.1 cm). Fluorescein test was negative as well as FIV/FeLV immunochromatography testing. Feline herpesvirus investigation was not possible. The patient was anesthetized and a lesion specimen was acquired with a cotton swab scraping and a fine needle aspiration. Cytology showed predominance of eosinophils and mast cells, with rare corneal epithelial cells, with smear background containing mast cell granules and free eosinophils. Presumptive diagnosis was eosinophilic keratoconjunctivits. After 14 days of topical corticosteroid (prednisolone acetate 1% every 8 h) the patient showed complete remission of the lesions with no relapse in 48 days.Discussion: Misdiagnosis and consequently mistreatment seems a greater prejudice than the risks associated with sample collection of keratoconjunctival proliferative lesions. Due to the lack of cytobrush or cotton swab, apparently, the reported patient was not submitted to ophthalmic cytology due to reluctance of the staff regarding fine needle aspiration of the cornea lesion. Despite a greater risk of iatrogenic trauma with needle aspiration, with eye anatomy well defined, level size and movement amplitude respected, it is unlikely that severe complications could occur. In this case, the undiagnosed patient was submitted to unnecessary 15 days of topical antibiotic and nonsteroidal anti-inflammatory, and no improvement of the clinical signs was observed. Despite non-recommended, few clinical trials as well as case descriptions are available comparing nonsteroidal and corticosteroid treatment of the disease. Once with diagnosis and beginning of topical prednisolone acetate 1% exclusively, the patient showed continuous improvement until complete remission of clinical signs after 14 days. This report reinforces the recommendation of corticosteroid therapy for feline eosinophilic keratoconjunctivitis and the absence of efficacy of nonsteroidal drugs. It also highlights the importance of diagnosis before any medical treatment is considered.

Chitosan-based films containing nanoemulsions of methyl salicylate: Formulation development, physical-chemical and in vitro drug release characterization

Transdermal patches for analgesic purposes are widely used, however, their occlusive characteristics can often cause allergic reactions, irritating contact dermatitis, and allergic contact dermatitis upon extended use. Chitosan is a natural positively charged bioadhesive polysaccharide with several biological properties, being promising templates for sustained and controlled topical or transdermal drug delivery. Methyl salicylate (MS) is a non-steroidal topical anti-inflammatory drug (NSAID). MS is a lipophilic oily drug commonly found in transdermal patches, being difficult to incorporate into hydrophilic formulations such as Chitosan-based films. Thus, MS is a good candidate to be encapsulated into nanoemulsions (NE). This work reports the formulation development, physical-chemical characterization, and in vitro drug release of NE-loaded Chitosan films formulated with MS, as a novel substitute for transdermal analgesic patches. MS was encapsulated into NE, which were prepared by ultrasonication and presented 29.3 nm ± 0.1 and PdI 0.167 ± 0.005. The incorporation of MS into NE prevented phase separation and provided a homogeneous physical blending formulation, as confirmed by FTIR, TGA. NE-loaded films provided high drug incorporation in the films 94.08% ± 6.63%), and a smaller crystallinity degree in comparison with physical mixture films, suggesting a plasticizing effect of nano-sized droplets. Besides, mean weight, thickness, and moisture content were increased in NE-loaded films in comparison with chitosan-based control films. In vitro drug release from NE-loaded films was significantly higher than for physical mixture films, following Weibull and Korsmeyer-Peppas release kinetics models. The results suggest that NE-loaded chitosan film can increase the drug loading capacity of oil drugs and successfully control in vitro release, constituting a novel approach for transdermal drug delivery of NSAIDs.

Consensus statements on pediatric atopic dermatitis from dermatology and pediatrics practitioners in Japan: Goals of treatment and topical therapy

BackgroundPediatric atopic dermatitis (PAD) is a pluricausal disease and is frequently seen in dermatological and pediatric practice. Therefore, it is important to find common views in clinical practice and to promote consensus among practitioners. Aiming to obtain common views among dermatologists and pediatricians and to disseminate them widely in clinical practice, we held the PAD Consensus Forums described herein. MethodsQuestionnaire surveys of treatment goals and drug therapy were conducted to prepare topics for discussion at the PAD Consensus Forums. Reaching consensus was defined as agreement among at least 70% of the participants. ResultsAs a result of discussion among 24 dermatologists and 25 pediatricians, consensus was obtained on 7 topics. These topics configure 3 consensus of treatment goals (Attainment targets were divided into the short/medium term and the long term. Attainment targets were associated with the primary evaluation domains of the Harmonising Outcome Measures for Eczema (HOME) roadmap, etc.) and 4 consensus of drug therapy (The number of applications of topical anti-inflammatory drugs in the acute phase and selection and ideal intervals between applications of topical anti-inflammatory drugs in proactive therapy, etc.). ConclusionsThe consensus is expected to help practitioners set appropriate treatment goals in clinical practice and facilitate the choice of drugs for treatment.

Evidence-Based Recommendations on the Pharmacological Management of Osteoarthritis and Chronic Low Back Pain: An Asian Consensus

The overall burden of chronic musculoskeletal pain in Asian countries will continue to increase as the population ages, as will the demand for safe and effective pain management. Currently available Asian guidelines are mostly outdated and targeted only to primary care. Implementation of international guidelines may be unsuitable for Asian patients due to cultural, local economic and regulatory factors. With the aim of developing Asian-specifi c consensus recommendations for the pharmacological management of osteoarthritis (OA) pain and chronic low back pain (cLBP), we convened to review and discuss recent available evidence for pharmacotherapy, clinical experiences, and current practice challenges they face in the region, including challenges in opioid use. Taking these into consideration, we provided general recommendations for the overall assessment and management of OA pain and cLBP. The strength of the recommendations regarding the use of pharmacological agents was assessed using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. Where evidence is confl icting or limited, we made no recommendation pending the availability of further evidence. We recommend topical non-steroidal anti-infl ammatory drugs (NSAIDs) as a fi rst-line pharmacological treatment of OA pain, while oral NSAIDs should be considered as a fi rst-line pharmacological treatment of cLBP. Acetaminophen has been commonly used as the fi rst-line treatment for OA pain and cLBP, but its long-term use is not recommended based on recent evidence. These consensus recommendations are not prescriptive, and serve as a guide for decision-making in clinical practice. The optimal management of OA pain and cLBP should ultimately be individualized to each patient.

Management of ocular allergy.

The treatment and management of ocular allergy (OA) remain a major concern for different specialties, including allergists, ophthalmologists, primary care physicians, rhinologists, pediatricians, dermatologists, clinical immunologists, and pharmacists. We performed a systematic review of all relevant publications in MEDLINE, Scopus, and Web Science including systematic reviews and meta-analysis. Publications were considered relevant if they addressed treatments, or management strategies of OA. A further wider systematic literature search was performed if no evidence or good quality evidence was found. There are effective drugs for the treatment of OA; however, there is a lack an optimal treatment for the perennial and severe forms. Topical antihistamines, mast cell stabilizers, or double-action drugs are the first choice of treatment. All of them are effective in reducing signs and symptoms of OA. The safety and optimal dosing regimen of the most effective topical anti-inflammatory drugs, corticosteroids, are still a major concern. Topical calcineurin inhibitors may be used in steroid-dependent/resistant cases of severe allergic keratoconjunctivitis. Allergen-specific immunotherapy may be considered in cases of failure of first-line treatments or to modify the natural course of OA disease. Based on the current wealth of publications and on the collective experience, recommendations on management of OA have been proposed.

A Novel ZnO Nanoparticle as Drug Nanocarrier in Therapeutic applications: Kinetic Models and Error Analysis

Nanotechnology provides promising possibilities for several biomedical and pharmaceutical applications in the medicine industry. Nanostructures play a major role in the recent strategies of technology suitable for novel drug applications. In this work, clindamycin phosphate (CliP) (topical anti-inflammatory drug), xanthan gum (XaG) (biopolymer) and ZnO (zinc oxide) (nanoparticle) nanostructures were synthesised using the sonochemical technique at room temperature. The characterization of the clindamycin phosphate- xanthan gum/ZnO (CliP-XaG/ZnO) nanostructure has been carried out by Fourier transform infrared (FTIR) and X-ray diffraction (XRD). The spectroscopic experiments elucidated in vitro the mechanism of drug delivery system at different pH media (1.2 and 7.4). In this study, the concentration of drug in the solution was analyzed by UV–vis spectroscopy method and several kinetic models and error analysis were calculated to prove a connection with results. The Higuchi model had the best correlation parameters. The percentage of swelling ratio (%) reached up 105% in XaG (pH 1.2) and 190% in XaG/ZnO (pH 1.2) And the swelling ratio (%) reached up 530% within in XaG (pH 7.4) and 655% within in XaG/ZnO (pH 7.4). The results show that the capacity of XaG / ZnO can be preferred as a novel topical anti-inflammatory drug carrier.

Dry eye disease immune responses and topical therapy

There is accumulating evidence that inflammation is one of the key components of dry eye because chronic ocular surface inflammation can be both a result as well as an initiator of dry eye. The need for continuing anti-inflammatory therapy may be determined in part by the extent that non-modifiable factors such as gender and age-related aqueous or lipid or mucus production deficiencies contribute to its chronicity. This perspective examines how the need for increased dosage of a topical anti-inflammatory drug may be determined by the degree of difficulty that a topically administered drug has in accessing different sites of tear deficiency and associated inflammation.

696 A straightforward preclinical efficacy assessment approach to identify promising drug candidates for development of novel topical anti-inflammatory drugs

696 A straightforward preclinical efficacy assessment approach to identify promising drug candidates for development of novel topical anti-inflammatory drugs

New progress of diagnosis and treatment in pseudophakic cystoid macular edema

Pseudophakic cystoid macular edema (PCME) is one of the most common complications of cataract surgery.It is the main cause of postoperative visual loss.PCME pathogenesis is unclear yet, inflammation is supposed to be an important cause.Systemic or local diseases, and complicated surgical operations may increase the risk of PCME.Diabetes is the most common independent risk factor, and the risk of PCME is closely related to severity of preoperative diabetes.Typical clinical symptoms of PCME include acute vision loss after surgery.In PCME eyes, fundus fluorescein angiography (FFA) can show the petal-like spots characteristically, and visual disc dot staining can be seen later.Cystoid macular edema (CME) first appears in the inner nuclear layer (INL) and gradually develops in the outer plexiform layer (OPL). Finally, fluid accumulates in the subretinal space.Besides, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have new advances in differential diagnosis between PCME and diabetic macular edema (DME). In practice, topical non-steroid anti-inflammatory drugs (NSAIDs) or glucocorticoids are generally used as first-line treatment medicines.Anti-vascular endothelial growth factor (anti-VEGF) also attracts attention as a new treatment.Individualized prevention and treatment is required for specific types of PCME.It still lacks a common recognized treatment of PCME, and long-term efficacy of the current treatment remains to be observed more rigorous and comprehensive experimental programs are required. Key words: Pseudophakic cystoid macular edema; Diabetic macular edema; Optical coherence tomography angiography; Anti-vascular endothelial growth factor; Femtosecond laser assisted

Preliminary Report on the Role of Dry Needling Versus Corticosteroid Injection, an Effective Treatment Method for Plantar Fasciitis: A Randomized Controlled Trial

Plantar fasciopathy (PF) is a common disorder for which there is no consensus regarding an optimal treatment strategy. We hypothesized that dry needling would be as effective as the use of corticosteroid injections for treating PF while avoiding the potential adverse effects of corticosteroids. After approval was received from the institutional review board, patients diagnosed with PF were prescribed a 3-week nonoperative treatment regimen. In addition to using oral and topical antiinflammatory drugs, patients engaged in plantar fascia and gastrocnemius stretching exercises. A study population of 98 patients was planned. An appointment was made in the third week of first-line treatment. Patients whose pain did not abate and who required further treatment were included in the study. One week later, we randomly divided patients into 2 groups using an online random number generator. Group 1 underwent dry needling, and group 2 underwent corticosteroid injection. All dry needling was performed by a single physiotherapist, and all corticosteroid injections were performed by the second author. Patients were assessed in the third week and sixth month by a single investigator using the foot function index. In terms of foot function index scores, dry needling caused significant decrease in the third week and also in the sixth month. However, although corticosteroid use led to a significant decrease at the third week, it lost efficacy in the sixth month (p < .001). In conclusion, dry needling seems to be a reliable procedure for treating PF, with better outcomes than corticosteroid injection.

English

Atopic dermatitis (AD) is a recurrent and chronic skin disease characterized by dysfunction of the epithelial barrier, skin inflammation, and immune dysregulation, with changes in the skin microbiota and colonization by Staphylococcus aureus being common. For this reason, the therapeutic approach to AD is complex and should be directed at restoring skin barrier function, reducing dehydration, maintaining acidic pH, and avoiding superinfection and exposure to possible allergens. There is no curative treatment for AD. However, a series of measures are recommended to alleviate the disease and enable patients to improve their quality of life. These include adequate skin hydration and restoration of the skin barrier with the use of emollients, antibacterial measures, specific approaches to reduce pruritus and scratching, wet wrap applications, avoidance of typical AD triggers, and topical anti-inflammatory drugs. Anti-inflammatory treatment is generally recommended during acute flares or, more recently, for preventive management. Nevertheless, the selection of the pharmacologic agent, as well as its potency, duration, and frequency of application must be in accordance with the severity of the disease and the distribution and type of the lesion. The objectives of this review are to emphasize the importance of basic skin care and to describe current and novel topical therapies for AD.

In Vivo Study of the Action of a Topical Anti-Inflammatory Drug In Rat Teeth Submitted To Dental Bleaching.

Bleaching gel containing hydrogen peroxide (H2O2) cause damages in pulp tissue. This study investigated the action of a topical anti-inflammatory, the Otosporin®, in rats' bleached teeth with the null hypothesis of which the Otosporin® is no able to minimize the pulp inflammation that bleaching gel generates. The rat's molars were divided into groups: BLE: bleached (35% H2O2 concentration /single application of 30 min); BLE-O: bleached followed by Otosporin® (10 min); and control: placebo gel. In the second day after dental bleaching, the rats were killed, and the jaws were processed for hematoxylin-eosin and immunohistochemistry analysis for tumor necrosis factor alpha (TNF-α), interleukin (IL)-6 and IL-17. The data collected were subjected to Kruskal-Wallis and Dunn statistical tests with at a 5% level of significance (p<0.05). The BLE group had moderate to strong inflammation in the occlusal third of the coronary pulp, with necrotic areas; and BLE-O, mild inflammation (p<0.05). There was a significant difference in the occlusal and middle thirds of the coronary pulp between the BLE with BLE-O and control groups (p<0.05). There was no difference in the cervical third (p>0.05). The BLE group had a high immunoexpression of TNF-α than BLE-O and control groups (p<0.05), with moderate and mild immunoexpression, respectively. Regarding IL-6 and IL-17, the BLE group had higher immunoexpression than control (p<0.05); the BLE-O was similar to the control (p>0.05). The topical anti-inflammatory Otosporin® can reduce pulp inflammation after dental bleaching in the rat teeth.

1095 Evaluating IKK 16 and ACHP as anti-inflammatory agents for treatment of skin inflammation: In vitro and in vivo

The skin faces the greatest exposure to environmental agents which contribute to the skin’s susceptibility to developing acute and chronic inflammation. NFκB and its upstream modulators, regulate many inflammatory mediators that contribute to inflammation. In the present study, we examined the anti-inflammatory properties of two P-gp substrates that are inhibitors of IêB kinase (IKK), ACHP and IKK 16, and evaluated their potential as topical anti-inflammatory drugs through inhibition of NFκB signaling. P-gp, or MDR1, is expressed in human and mouse skin, and we hypothesized that P-gp substrates would make good candidates for transdermal delivery of topically-applied drugs because P-gp can facilitate their absorptive transport into the systemic circulation. An Pgp-mediated efflux assay revealed both IKK 16 and ACHP were high affinity P-gp substrates/inhibitors, and IKK 16 and ACHP completely blocked nuclear translocation of NFκB in human and murine keratinocytes challenged with IL-1a. Pretreating primary keratinocytes with IKK 16 or ACHP blocked cytokine gene expression induced by IL-1a, TNFa, and PMA in a dose-dependent manner. This indicated that both drugs block the inflammatory signaling pathway downstream of NFκB activation in vitro. However, in vivo studies showed topical ACHP treatment, but not IKK 16, blocked PMA induced cytokine expression in K5-PKCa mice, a mouse skin inflammation model. Further studies revealed that the topical application of ACHP reduced both skin inflammation induced by Imiquimod and tumor formation in DMBA initiated and PMA promoted K5-PKCa mice. In this model ACHP application was not effective at eliminating established tumors. Pretreatment of ACHP also attenuated cytokine expression induced by UV irradiation of FVB mice. These data indicate that ACHP is a potential candidate for a topical drug used for treating skin inflammation that is mediated by NFκB signaling.

Postoperative Pain Management in Vitreoretinal Surgery for Retinal Detachment: A Systematic Review of Randomized Controlled Trials

Purpose:The purpose of this study is to examine the evidence for postoperative pain management in patients undergoing vitreoretinal surgery for retinal detachment by systematic review.Methods:A systematic review of the literature was performed using multiple databases in July 2016 and September 2017. Two independent reviewers screened titles and abstracts and analyzed selected papers in detail. Included studies assessed patients undergoing vitreoretinal surgery for retinal detachment and described postoperative pain management. Risk of bias was assessed using the criteria outlined in the “risk of bias” tool in the Cochrane Handbook for Systematic Reviews of Interventions.Results:Nine randomized controlled studies comprising 517 patients met the inclusion criteria. Pain management included perioperative peribulbar, sub-Tenon, and retrobulbar anesthetic block; perioperative systemic anti-inflammatory and postoperative systemic and topical anti-inflammatory drugs; and ice compress. Pain scores were assessed with nominal, numerical, and visual analog scales. Risk of bias was low for 2 studies, unclear for 4 studies, and high for 3 studies. All studies reported better postoperative pain scores with the active treatment group except for a single study comparing retrobulbar chirocaine with and without clonidine. No serious adverse events were reported for any of the studies.Conclusion:Heterogeneity of studies did not allow for meta-analysis, but qualitative analysis suggests that pain relief can be achieved in the short term with a variety of treatment interventions. Additional study is required to specifically examine pain management strategies according to the characteristics of the anesthesia and surgery as well as the needs of the patient.

Topical Dexamethasone Administration Impairs Protein Synthesis and Neuronal Regeneration in the Olfactory Epithelium

Chronic inflammatory process in the nasal mucosa is correlated with poor smell perception. Over-activation of immune cells in the olfactory epithelium (OE) is generally associated with loss of olfactory function, and topical steroidal anti-inflammatory drugs have been largely used for treating such condition. Whether this therapeutic strategy could directly affect the regenerative process in the OE remains unclear. In this study, we show that nasal topical application of dexamethasone (DEX; 200 or 800 ng/nostril), a potent synthetic anti-inflammatory steroid, attenuates OE lesion caused by Gram-negative bacteria lipopolysaccharide (LPS) intranasal infusion. In contrast, repeated DEX (400 ng/nostril) local application after lesion establishment limited the regeneration of olfactory sensory neurons after injury promoted by LPS or methimazole. Remarkably, DEX effects were observed when the drug was infused as 3 consecutive days regimen. The anti-inflammatory drug does not induce OE progenitor cell death, however, disturbance in mammalian target of rapamycin downstream signaling pathway and impairment of protein synthesis were observed during the course of DEX treatment. In addition, in vitro studies conducted with OE neurospheres in the absence of an inflammatory environment showed that glucocorticoid receptor engagement directly reduces OE progenitor cells proliferation. Our results suggest that DEX can interfere with the intrinsic regenerative cellular mechanisms of the OE, raising concerns on the use of topical anti-inflammatory steroids as a risk factor for progressive olfactory function impairment.